• Jonathan

Separate Text From Context And All That Remains Is The Con. Part 2

Learner Context: Stress, Failure and Cognitive Load.


Experiential learning, as distinct from didactic learning depends on realistic emotional investment from learners. We design cognitive load and stress levels into the instructional design and delivery of our courses. In the simulation suites we are able to change ambient noise, smell, lighting and temperature as well as simulated location to enhance the student's clinical development. Manipulation of these variables coupled with the use use of high fidelity manikins and simulated monitoring equipment (ALSi) all adds to the realism and increases their emotional investment while in a safe environment. It is an unrealistic expectation to anticipate that learners will be able to perform under clinical conditions when they have never been exposed to similar situations and environments. This is why deliberate learning and mastery is essential and the concept of "meaningful" practice so important. Published studies of stress and cognitive load are mostly qualitative. One such study examined the use of cognitive aids during simulated resuscitation in which 85% of students used aids but still performed incorrect management in 25% of the cases. Stressful training experiences may, in theory prepare students for the high-stress clinical environment but excessively stressful training scenarios may overwhelm them both emotionally and cognitively. This almost certainly will have a negative impact on their learning. The right balance must be sought and the student should learn that failure is part of the learning process too. They must also experience that despite their best efforts the desired outcome is never guaranteed. To always simulate patient improvement when correct interventions are performed efficiently and in the correct sequence leaves the learner with unrealistic expectations that can have a tremendous negative impact upon them once placed in the clinical environment.

The use of the sim suites allows for in situ simulation training. We are able to closely simulate the learners' working environment. We are able to provide bespoke training tailored specifically to client requirement. We can come to your specified location and record the environment you wish to simulate at a time of your choosing. This obviously reduces your operational impact without compromising on the context of the training. In situ simulation can be used as a strategy to train individuals and/or healthcare teams. The objectives for in situ training can be individual provider technical skills or team based skills development including communication, leadership, role allocation and situational awareness. One distinct advantage of in situ simulation learning is that it provides the participants with a more realistic training environment. The result is improved learning, performance and/or better patient outcomes. Compared with no intervention, in situ training added to other educational strategies has a positive impact on learning outcomes (eg improved team performance, improved time to critical tasks) performance change in the real clinical environment (eg improved recognition of a deteriorating patient) and improved patient outcomes.

Looking at the current beginner EMS educational offerings there is very little or no clinical experience required so these learners have to put their classroom education into context through on-the-job training. The problem with that approach is that experience on the job is only beneficial if it’s good experience. Too often, the learner gets partnered with the medic who has an opening on their truck, and the reason that they always have an opening is that nobody else is willing to work with them. That’s the problem with experience as a teacher in our field: often your only context comes from a partner who is more cautionary tale than mentor; the type of medics I refer to as having one year of experience repeated 25 times.

When you’re new and inexperienced, it’s difficult to separate good practices from bad, and you’re particularly susceptible to believing it when some lazy burnout proclaims, “There’s the way it’s done in class, and there’s the way it’s done on the street.” When the clinical experience is lacking, what you wind up with is students who know how to perform psychomotor skills but not why, or even more importantly, why not. We at EMTG hit the basics hard so that they are better equipped to distinguish the war stories they hear from the fairy tales.


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